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South Carolina rates for HCPCS L3763

Elbow Wrist Hand Orthosis Rigid Without Joints May Include Soft Interface Straps Custom Fabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.23 / $433.23 / $1,431.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.51 / $433.23 / $1,557.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.73 / $863.01 / $1,053.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $539.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $620.42 / $697.57
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.17 / $657.80 / $1,416.32
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,034.43 / $1,034.43 / $1,034.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.47 / $591.47 / $591.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.12 / $406.97 / $689.62